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Difference between revisions of "Whipple's disease"
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| Caption = Whipple's disease. [[H&E stain]]. | | Caption = Whipple's disease. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = rod-shaped microorganisms - typically in macrophages; lamina propria macrophages usually abundant | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[mycobacterium avium complex]] | | LMDDx = [[mycobacterium avium complex]] | ||
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| Tx = antibiotics | | Tx = antibiotics | ||
}} | }} | ||
'''Whipple's disease''' is a rare infectious disease that is classically in the [[duodenum]]. | '''Whipple's disease''' is a rare infectious disease that is classically found in the [[duodenum]]. | ||
==General== | ==General== | ||
Etiology: | Etiology: | ||
*Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped | *Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped organism.<ref name=pmid11764080>{{Cite journal | last1 = Alkan | first1 = S. | last2 = Beals | first2 = TF. | last3 = Schnitzer | first3 = B. | title = Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii. | journal = Am J Clin Pathol | volume = 116 | issue = 6 | pages = 898-904 | month = Dec | year = 2001 | doi = 10.1309/7678-E2DW-HFJ5-QYUJ | PMID = 11764080 }}</ref> | ||
Epidemiology: | Epidemiology: | ||
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Treatment: | Treatment: | ||
*Antibiotics - for months and months. | *Antibiotics - for months and months. | ||
==Gross== | |||
*Pale yellow or white spots.<ref>{{Cite journal | last1 = Salkic | first1 = NN. | last2 = Alibegovic | first2 = E. | last3 = Jovanovic | first3 = P. | title = Endoscopic appearance of duodenal mucosa in Whipple's disease. | journal = Gastrointest Endosc | volume = 77 | issue = 5 | pages = 822-3; discussion 823 | month = May | year = 2013 | doi = 10.1016/j.gie.2013.01.016 | PMID = 23490230 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147 | doi=10.1016/S1542-3565(04)00387-8}}</ref> | Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147 | doi=10.1016/S1542-3565(04)00387-8}}</ref> | ||
* | *Rod-shaped microorganisms - typically found in macrophages. | ||
**Macrophages usually abundant - '''key feature''' that should raise Dx in DDx. | **Macrophages usually abundant - '''key feature''' that should raise Dx in DDx. | ||
**Organisms periodic acid-Schiff (PAS) positive. | **Organisms periodic acid-Schiff (PAS) positive. | ||
DDx: | DDx: | ||
*[[Mycobacterium avium complex]] (MAC). | *[[Mycobacterium avium complex]] (MAC) - not hole-y. | ||
*Crushed Brunner's glands - PAS-Alcian blue stain +ve (like Whipple's disease). | |||
===Images=== | ===Images=== | ||
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Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC) | Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC) | ||
</gallery> | </gallery> | ||
==Stains== | ==Stains== | ||
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*[[AFB stain]] -ve -- to r/o [[MAI]]. | *[[AFB stain]] -ve -- to r/o [[MAI]]. | ||
===Images=== | |||
*[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)]. | *[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)]. | ||
*[https://www.flickr.com/photos/euthman/6881958781/ Whipple disease - PAS (flickr.com/euthman)]. | |||
==See also== | ==See also== | ||
*[[Duodenum]]. | *[[Duodenum]]. | ||
*[[Colorectal xanthomatous polyp]]. | |||
==References== | ==References== | ||